Epidemiological features of acute medial meniscus posterior root tears.

PURPOSE: Untreated or overlooked medial meniscus posterior root tears (MMPRTs) induce sequential knee joint degradation. We evaluated epidemiological features of acute MMPRT for its early detection and accurate diagnosis. METHODS: Among 330 MMPRT patients from 2018 to 2020, those who underwent arthroscopic pullout repairs were enrolled. Patients who underwent non-operative treatment or knee arthroplasty, those with a cruciate ligament-deficient knee or advanced osteoarthritis of the knee, and those with insufficient data were excluded. Finally, we retrospectively evaluated data from 234 MMPRTs (female: 79.9%, complete tears: 92.7%, mean age: 65 years). Welch's t-test and Chi-squared test were used for pairwise comparisons. Spearman's rank correlation analysis was performed between age at surgery and body mass index (BMI). Multivariable logistic regression analysis with stepwise backward elimination was applied to the values as risk factors for painful popping events. RESULTS: In both sexes, there were significant differences in height, weight, and BMI. In all patients, there was a significant negative correlation between BMI and age (ρ = - 0.36, p < 0.001). The BMI cutoff value of 27.7 kg/m2 had a 79.2% sensitivity and a 76.9% specificity for detecting MMPRT patients aged < 50 years. A painful popping event was confirmed in 187 knees (79.9%), and the frequency was significantly reduced in partial tears as compared to complete tears (odds ratio: 0.080, p < 0.001). CONCLUSION: Higher BMI was associated with a significantly younger age of MMPRT onset. Partial MMPRTs had a low frequency of painful popping events (43.8%).

Ipsilateral Periprosthetic Fractures above and below the Knee Associated with Navigation Tracker Pin and Bone Fragility.

We report a case of ipsilateral periprosthetic fractures above and below the knee that occurred at different times due to navigation tracker pin and bone fragility. A 66-year-old Japanese woman with rheumatoid arthritis (RA) underwent a total knee arthroplasty. Four months post-surgery, a periprosthetic fracture above the knee at the navigation pin hole was detected. She underwent osteosynthesis and could walk independently, but she developed an ipsilateral tibial component fracture. Conservative treatment with a splint was followed by bone union. Patients with RA treated with oral steroids tend to develop ipsilateral periprosthetic fractures around the knee due to bone fragility.

Arthroscopic Meniscal Healing following Medial Meniscus Posterior Root Repair: A Comparison between Two Suture Materials.

Recently, transtibial pullout repair of the medial meniscus (MM) posterior root tear (PRT) has become widely accepted and provides satisfactory clinical outcomes. Widening after cyclic loading or ultimate failure load using different suture materials and configurations has been studied. However, no study has compared the clinical outcomes using different suture materials. This study aimed to evaluate the clinical outcomes after performing MMPRT pullout repair using different suture materials. We hypothesized that better clinical outcomes would be achieved using ultra-high molecular weight polyethylene (UHMWPE) tape compared with a normal polyester suture. Thirty-seven patients who underwent MM posterior root repair between November 2019 and May 2020 were retrospectively investigated. Pullout repair was performed using a hollow no. 0 polyester suture (n = 14) and UHMWPE tape (n = 23). Clinical outcomes were assessed preoperatively and at 1 year postoperatively, using the Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score, and visual analogue scale (VAS) pain score. The meniscal healing status was assessed using an arthroscopic scoring system (range: 0-10). All clinical scores were improved significantly in both groups. However, significantly higher meniscal healing scores and decreased VAS pain scores were observed in the UHMWPE group (7.3 ± 0.9 and 7.7 ± 11.3, respectively) than in the polyester group (5.6 ± 2.1 and 18.4 ± 18.6, respectively; p < 0.01). Suture cut-out and loss of the root continuity were observed in some cases (three cases [21.4%] in the polyester suture group and one case [4.3%] in the UHMWPE tape group). Both suture materials led to satisfactory clinical outcomes at 1 year postoperatively, whereas the UHMWPE tape was useful for obtaining good meniscal healing and decreasing the VAS pain score.

Medial meniscus posterior root repair influences sagittal length and coronal inclination of the anterior cruciate ligament: a retrospective study.

PURPOSE: Medial meniscus (MM) posterior root tears (PRTs) lead to abnormal kinematic changes in the knee and may induce pathological external rotation of the tibia during knee flexion. This study aimed to investigate changes in the length and inclination of the anterior cruciate ligament (ACL) after MM posterior root repair using magnetic resonance imaging (MRI). METHODS: This retrospective study included 44 patients who underwent MM posterior root repair between 2016 and 2019. Clinical outcomes were evaluated before and after surgery. MRI examinations were performed at 10°/90° of knee flexion preoperatively and 3 months postoperatively. The ACL length, proximal angle, and distal angle were determined using the sagittal view. MM extrusion and ACL inclination angle were determined using the coronal view. RESULTS: Clinical outcomes significantly improved 1 year after surgery. The postoperative ACL length (29.7 ± 2.4 mm) and proximal angle (47.0 ± 7.4°) at 90° of knee flexion decreased relative to the preoperative values (31.5 ± 2.3 mm and 51.8 ± 8.7°, P < 0.01). The postoperative ACL inclination (64.9 ± 5.6°) at 10° of knee flexion decreased relative to the preoperative value (69.7 ± 5.6°, P < 0.01). CONCLUSION: Pathologically-stretched linear ACL at 90° of knee flexion and a steep ACL inclination at 10° of knee flexion could be reduced after MM posterior root repair. This suggests that pullout repair could restore MM function as a secondary stabilizer, thereby preventing meniscal and cartilage degeneration.

The Evaluation of Meniscus Regenerative Effects of LIPUS-Induced CCN Proteins: Induction by LIPUS of CCN2 and Meniscus-Related Genes in Cultured Meniscus Cells and Meniscus Tissues.

Menisci are a pair of crescent-shaped fibrocartilages and composed primarily of type I collagen. Inner region of the meniscus has similar characteristics to articular cartilage. Low-intensity pulsed ultrasound (LIPUS) has been reported to have chondroprotective effects on chondrocytes by inducing the expression of chondrocyte differentiation markers and CCN2/CTGF production. Here, we describe an experimental approach that investigates the distinct cellular behavior of human inner and outer meniscus cells in response to LIPUS stimulation. Our experimental model can analyze the relationships between LIPUS-induced CCN2 and its repairing role in the meniscus.

Steep posterior slope of the medial tibial plateau and anterior cruciate ligament degeneration contribute to medial meniscus posterior root tears in young patients.

PURPOSE: Medial meniscus posterior root tears (MMPRTs) occur most frequently in middle-aged and older adults. However, this serious condition can also occur in younger patients. The purpose of this study was to compare anterior cruciate ligament (ACL) degeneration and sagittal medial tibial slope in young adults with and without MMPRT. METHODS: Eighteen healthy volunteers, 18 young patients (20-49 years of age), and 30 middle-aged and older patients (50-70 years of age) with MMPRT repair were included in the study. Sex, body mass index (BMI), femorotibial angle, ACL degeneration, and medial tibial slope angle were compared among the groups. ACL degeneration and medial tibial slope angle were assessed using magnetic resonance imaging. RESULTS: In the healthy volunteer group, the young patient group, and the older patient group, the medial tibial slopes were 3.5° ± 1.4°, 6.1° ± 2.7°, and 7.2° ± 1.9°, respectively, and the ACL degeneration rates were 5.6%, 38.9%, and 43.3%, respectively. Young patients with MMPRT had significantly steeper medial tibial slopes and ACL degeneration compared to those of the healthy volunteers (P < 0.05). The parameters of young patients were similar to those of older patients with MMPRT. In the multivariate logistic regression analysis, BMI, medial tibial slope, and ACL degeneration were significantly associated with MMPRT in young patients. CONCLUSION: BMI, steep medial tibial slope, and ACL degeneration contribute to MMPRT development in younger patients. LEVEL OF EVIDENCE: Level III.

Clinical evaluation of suture materials for transtibial pullout repair of medial meniscus posterior root tear.

BACKGROUND: There are no recommendations for specific suture materials in transtibial pullout repair of medial meniscus posterior root tears. This study aimed to evaluate the clinical outcomes of transtibial pullout repair of medial meniscus posterior root tears using ultrahigh-molecular-weight polyethylene sutures and suture tape. METHODS: We retrospectively reviewed the data of 36 patients (27 women and 9 men, mean age 64.1 years) who had undergone transtibial pullout repair of medial meniscus posterior root tears between November 2018 and December 2019. Two groups of 18 patients each received either two different cord-like sutures or suture tape. Clinical parameters were assessed preoperatively and on second-look arthroscopy (mean postoperative period 12 months). The meniscal healing status was assessed using a previously published scoring system (ranging from 0 to 10), and the incidence rate of suture cut-out was assessed on second-look arthroscopy. RESULTS: All clinical scores significantly improved in both groups, with no significant between-group differences on second-look arthroscopy. The arthroscopic meniscal healing scores significantly differed between sutures (mean 6.7 points) and suture tape (mean 7.4 points; p = 0.044). No significant between-group difference in the suture cut-out rate was observed. CONCLUSIONS: This study found no significant differences in the clinical outcomes between ultrahigh-molecular-weight polyethylene sutures and suture tape. Favorable clinical outcomes were obtained using both types of suture; however, the usefulness of suture tape appears to be limited.

Clinical outcomes of medial meniscus posterior root repair: A midterm follow-up study.

BACKGROUND: Transtibial pullout repair of medial meniscus posterior root tears (MMPRTs) cannot prevent the progression of knee osteoarthritis. Conversions of knee arthroplasties are occasionally required following MMPRT repair. However, other knee-related surgical treatments following MMPRT repair are unclear. This study was aimed at investigating the midterm clinical outcomes and knee-related surgical events following MMPRT repair. METHODS: Patients with MMPRT underwent pullout repair using FasT-Fix modified Mason-Allen (F-MMA) suturing with an all-inside meniscal repair device. Thirty-two patients with follow-up duration >2 years were enrolled. We assessed the clinical outcomes and postoperative surgical treatment of both knees. RESULTS: F-MMA pullout repair improved all clinical evaluation scores in patients with MMPRT at a mean follow-up of 36.1 months. Postoperative arthroscopic debridement was required for one patient. An additional MMPRT repair was performed in one patient on second-look arthroscopy. None of the patients required ipsilateral knee arthroplasty. In the contralateral knees, one pullout repair of a newly developed MMPRT and two knee arthroplasties were performed. CONCLUSIONS: This study demonstrated that F-MMA pullout repair yielded satisfactory clinical outcomes. However, subsequent knee-related surgeries were observed in 6.3% of the pullout-repaired knees and 9.4% of the contralateral knees. Our results suggest that surgeons should be aware of the worsening and/or occurrence of contralateral knee joint disease, even when the postoperative clinical outcomes are satisfactory following MMPRT repair. LEVEL OF EVIDENCE: IV.

Transtibial Pullout Repair of Lateral Meniscus Posterior Root Tear with Tissue Loss: A Case with Anterior Cruciate Ligament Injury and Medial Meniscus Tear.

Lateral meniscus (LM) posterior root tear (LMPRT) is mainly caused by trauma, especially trauma associated with anterior cruciate ligament (ACL) injuries. Although a transtibial pullout repair or a side-to-side repair is commonly performed for LMPRT, to the best of our knowledge, there is no clinical report of LMPRT with tissue loss using the pullout technique. Thus, the purpose of this report was to describe a clinical, radiographic, and arthroscopic outcome after pullout repair for a case of LMPRT with a large defect with a chronic ACL tear and complex medial meniscus (MM) tears. A 31-year-old man complained of knee pain and restricted range of motion after twisting his knee when he stepped on an iron pipe. The patient had a football-related injury to his right knee 14 years before presentation, and since then, the patient's knee has given out more than 10 times but was left unassessed. Magnetic resonance imaging showed LMPRT with tissue loss, ACL tears, and complex MM tears. Transtibial pullout repair of the LMPRT with ACL reconstruction and MM repairs were performed. Following the pullout repair of the LMPRT, an approximately 6 mm gap remained between the LM posterior root and root insertion. However, magnetic resonance imaging and second-look arthroscopy at 1 year postoperatively revealed meniscal healing, gap filling with some regeneration tissue, of the LM posterior root. Furthermore, the lateral meniscus extrusion in the coronal plane improved from 3.1 mm (preoperative) to 1.6 mm (1 year postoperatively). Transtibial pullout repair with the remaining gap could be a viable treatment option for LMPRT with tissue loss, combined with ACL reconstruction.

Late-onset implant-related neuropathy: Three years after proximal humeral fracture.

There are currently no reports of implant-related neuropathy associated with humeral proximal fracture surgery. Herein, we report a case of implant-related late-onset neuropathy that developed 3 years after proximal humeral fracture surgery. A 51-year-old man underwent minimally invasive plate osteosynthesis for a left proximal humeral fracture 3 years prior. Left upper limb pain and reduced angle of elevation of the shoulder were recognized 1 month before the outpatient consultation. Numbness was noted on the ulnar side of the hand, and radiating pain to the ulnar nerve region was noted during shoulder abduction and compression of the medial side of the upper arm. Computed tomography revealed close proximity of the neurovascular bundle to the locking screw along with muscle atrophy around the shoulder. Hence, the patient was diagnosed with neuropathy. After implant removal, the pain in the ulnar nerve region improved, and the upper arm could be elevated. In our case, the cause of muscle atrophy was axillary nerve manipulation and cervical myelopathy caused by the operation. When late-onset neuropathy occurs, implant-related neuropathy with muscle atrophy should be considered.

Grade of Subchondral Insufficiency Fracture of the Knee and the Presence of a Posterior Shiny-Corner Lesion are Correlated with Duration of Medial Meniscus Posterior Root Tear in Women.

Bone marrow edema (BME) after meniscus injury and risk factors for subchondral insufficiency fracture of the knee (SIFK) have been reported. However, their association with medial meniscus posterior root tear (MMPRT) remains unknown. We investigated the association of BME volume (BME-V), posterior shinycorner lesion (PSCL), and SIFK with MMPRT to examine the correlations between BME-V and medial meniscus extrusion (MME), PSCL and duration from injury to the time of magnetic resonance imaging (duration), and SIFK and duration. Twenty-nine patients who underwent surgery for MMPRT were included (mean age, 59.2; range, 39-84). The presence of PSCL, femoral BME-V (cm3), and SIFK grade (1-4) were evaluated. Preoperative factors, such as MME (mm) and duration (weeks), were investigated using multivariate linear/ logistic regression analyses. Multivariate linear regression analysis revealed duration as a significant factor for high-grade SIFK (p<0.01). Multivariate logistic regression analysis revealed duration as a significant factor for the presence of PSCL (odds ratio=0.94, p<0.05). A long duration of MMPRT leads to severe MME and highgrade SIFK (3 and 4), often resulting in knee arthroplasty. Early diagnosis of MMPRT and pullout repair can prevent severe MME and high-grade SIFK.

Large flexion contracture angle predicts tight extension gap during navigational posterior stabilized-type total knee arthroplasty with the pre-cut technique: a retrospective study.

BACKGROUND: This study aimed to determine the predictors of tight extension gap (EG) compared with the flexion gap (FG) during navigational posterior stabilized-type total knee arthroplasty using the pre-cut technique. METHODS: Nineteen patients with tight EG (defined as FG-EG ≥2 mm after pre-cut; group T) and 84 patients with an approximately equal gap (defined as FG-EG = 0-1 mm after pre-cut; group E) were enrolled. Medial tibial slope angle, hip knee ankle angle, flexion contracture angle, and active maximum flexion angle were compared between the two groups. RESULTS: The multivariate logistic regression model indicated that the probability of tight EG increased with flexion contracture angle (odds ratio, 1.13; 95% confidence interval 1.05-1.20; P ≤ 0.001). According to the receiver operating characteristic analysis, the flexion contracture angle cut-off value associated with tight EG was 15.0° (sensitivity, 85%; specificity, 78%). CONCLUSION: This study demonstrated that a large flexion contracture angle (cut-off 15.0°) was associated with tight EG after pre-cut osteotomy during posterior stabilized-type total knee arthroplasty. Awareness of this risk factor may help improve preoperative predictability of tight EGs and preparedness for additional procedures, such as soft tissue release or capsulotomy, to correct them. LEVEL OF EVIDENCE: Level III.

Transtibial pullout repair techniques using two simple stitches for medial meniscus posterior root tear can prevent the progression of medial meniscus extrusion and obtain successful outcomes.

PURPOSE: Transtibial pullout repairs using two simple stitches (TSS) and a combination of TSS with posteromedial pullout repair (TSS + PMP) using an all-inside meniscal repair device have been reported previously for the treatment of medial meniscus (MM) posterior root tears. This study aimed to investigate the postoperative clinical outcomes of these techniques including MM extrusion (MME). METHODS: Fifty-two patients who underwent transtibial pullout repair were investigated and divided into TSS (n = 27) and TSS + PMP (n = 25) groups. The clinical outcomes were assessed using the Lysholm knee score and Knee Injury and Osteoarthritis Outcome Score 1 year postoperatively and compared between two groups. MME was measured using magnetic resonance imaging at 1 year postoperatively and compared between two groups. RESULTS: A significant improvement in each clinical score was observed in both groups, and no significant difference was seen in clinical outcomes. Moreover, no significant difference in postoperative MME was observed in both groups (TSS and TSS + PMP: 3.5 mm and 3.8 mm, respectively). Though no significant progression of MME was observed in TSS group, a significant progression of it was observed in TSS + PMP group postoperatively. CONCLUSIONS: This study demonstrated that both techniques improved clinical outcomes in the short-term postoperative period. However, MME was progressed significantly in TSS + PMP group 1 year postoperatively, which indicated that PMP might not be a useful additional procedure for reducing the postoperative MME.

Medial meniscus posterior root repairs: A comparison among three surgical techniques in short-term clinical outcomes and arthroscopic meniscal healing scores.

BACKGROUND: Medial meniscus (MM) posterior root repairs lead to favorable clinical outcomes in patients with MM posterior root tears (MMPRTs). However, there are few comparative studies in evaluating the superiority among several pullout repair techniques such as modified Mason-Allen suture, simple stitch, and concomitant posteromedial pullout repair. We hypothesized that an additional pullout suture at the MM posteromedial part would have clinical advantages in transtibial pullout repairs of the MMPRTs. The aim of this study was to compare the clinical usefulness among several types of pullout repair techniques in patients with MMPRTs. METHODS: Eighty-three patients who underwent arthroscopic pullout repairs of the MMPRTs were investigated. Patients were divided into three groups using different pullout repair techniques: a modified Mason-Allen suture using FasT-Fix all-inside meniscal repair device (F-MMA, n = 28), two simple stitches (TSS, n = 30), and TSS concomitant with posteromedial pullout repair using all-inside meniscal repair device (TSS-PM, n = 25). Postoperative clinical outcomes and semi-quantitative arthroscopic meniscal healing scores (0-10 points) were evaluated at second-look arthroscopies. RESULTS: No significant differences among the three groups were observed in patient demographics and preoperative clinical scores, except for preoperative Lysholm scores. At second-look arthroscopies, there were no significant differences among the three techniques in postoperative clinical outcomes and meniscal healing scores. CONCLUSIONS: This study demonstrated that the TSS-PM pullout repair technique did not show better scores in postoperative clinical outcomes and meniscal healings compared with the F-MMA and TSS techniques. Our results suggest that the concomitant posteromedial pullout suture may have no clinical advantage in the conventional pullout repairs for the patients with MMPRTs.

A posterior shiny-corner lesion of the tibia is observed in the early phase after medial meniscus posterior root tear.

BACKGROUNDS: Medial meniscus (MM) posterior root tear (PRT) results in joint overloading and degenerative changes in the knee, and pullout repair is recommended to prevent subsequent osteoarthritis. Diagnosing MMPRT is sometimes difficult, especially in the case of an incomplete tear. A posterior shiny-corner lesion (PSCL) is reported to be useful for diagnosis, although the association between MMPRT and PSCL is unknown. This study aimed to investigate the properties of PSCL, such as the location, volume, and duration from injury to the time of MRI (duration). We hypothesized that PSCL is observed in the early phase after the MMPRT onset. METHODS: T2-weighted fat-suppression magnetic resonance imaging (MRI) was obtained from 55 patients with MMPRT preoperatively. The prevalence of the PSCL; giraffe neck, cleft, and ghost signs; severe MM extrusion (> 3 mm); and the PSCL volume were evaluated. The PSCL lesion elliptical volume (mm3) was calculated by measuring the anteroposterior, transverse, and craniocaudal dimensions. RESULTS: PSCL was observed in 34 (62%) cases. The mean volume of the PSCL was 102.0 mm3. A significantly shorter duration was observed in the PSCL-positive group (5.6 weeks) than that in the PSCL-negative group (40.9 weeks, P < 0.01), although no significant correlation was observed between the PSCL volume and duration. The sensitivity for the MMPRT was 90.5% when the cut-off duration value was 3 weeks and 81.8% when the cut-off value was 8 weeks. CONCLUSIONS: MRI examination may detect PSCL if it is performed early following MMPRT onset. Detecting PSCL may be useful in diagnosing MMPRT with high sensitivity.

Postoperative external tibial rotation is correlated with inferior meniscal healing following pullout repair of a medial meniscus posterior root tear.

PURPOSE: The purpose of this study was to evaluate the influence of tibial rotation on the postoperative healing status of the medial meniscus (MM) following pullout repair of the MM posterior root tear (MMPRT). METHODS: Ninety-one patients (68 women and 23 men; mean age 63.3 ± 8.8 years) who had undergone transtibial pullout repair of MMPRT were enrolled in the study. The tibial external rotation angle (ERA) in each patient was measured postoperatively using computed tomography in the extended knee position. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period 12 months) using a previously published scoring system (range 0-10). The association between the ERA and the meniscal healing score was investigated using univariate linear regression models. The ERA cut-off for improved meniscal healing score (≥ 7) was determined using receiver-operating characteristic analysis. RESULTS: The ERA and the meniscal healing score were significantly associated, confirming that increased ERAs were correlated with worse meniscal healing status (R = - 0.28; P < 0.001). The optimum ERA cut-off value was 0.5°, with a sensitivity of 68% and a specificity of 63%. The mean meniscal healing scores were 7.3 and 6.2 among patients with ERAs < 0.5° and those with ERAs ≥ 0.5°, respectively (P < 0.001). CONCLUSION: This study demonstrated that the ERA was significantly correlated with the postoperative meniscal healing status. Postoperative tibial rotation could be one of the factors affecting postoperative outcomes of pullout repair of MMPRT. Controlling the tibial rotation may possibly improve meniscal healing. LEVEL OF EVIDENCE: III.

Comparison of two simple stitches and modified Mason-Allen suture for medial meniscus posterior root tear based on the progression of meniscal posterior extrusion: A retrospective cohort study.

Purpose: Medial meniscus (MM) posterior root (PR) tear leads to severe MM posterior extrusion (PE), resulting in rapid knee cartilage degeneration. MMPR repairs are recommended to reduce MMPE, especially during knee flexion. However, the difference in MMPE between different repair techniques remains unknown. This study aimed to investigate preoperative and postoperative MMPE following several pullout repair techniques. We hypothesized that a technique using two simple stitches (TSS) would be more useful than FasT-Fix-dependent modified Mason-Allen suture (F-MMA) to prevent the progression of MMPE in knee extension. Methods: This retrospective study included 35 patients who underwent MMPR repair. To compare MMPE, patients were divided into two groups according to the use of F-MMA while grasping the posterior capsule and TSS without grasping it. Open magnetic resonance imaging was performed at 10° and 90° knee flexion preoperatively, and at 3 and 12 months postoperatively, and the MMPE of both groups was evaluated. Results: A significant difference was observed between preoperative and 3-month postoperative MMPE at 90° knee flexion in both groups (p < .01). A significant difference was observed in 3- and 12-month postoperative MMPE at 10° knee flexion between both groups (p = .04/.02), whereas no significant difference in the preoperative MMPE at 10° knee flexion was observed between them (p = .45). Conclusions: Both repairs were found to be useful to reduce MMPE in knee flexion. Further, F-MMA repair increased MMPE in knee extension, unlike TSS repair. These findings suggest that TSS might have more advantages for load distribution when standing or walking.

Medial Meniscus Posterior Root Repair Using a Modified Mason-Allen Suture Can Prevent the Progression of Cartilage Degeneration on the Loading Surface of the Medial Compartment: A Second-Look Arthroscopic Evaluation.

The treatment of medial meniscus posterior root tears (MMPRTs) has evolved to include a variety of repair strategies. This study investigated the location of the articular cartilage degeneration during second-look arthroscopy after transtibial pullout repair with a modified Mason-Allen suture using FasT-Fix (F-MMA) in 22 patients with MMPRTs. Second-look arthroscopy was performed approximately 1 year postoperatively to eval-uate the healing status of the medial meniscus (MM). Articular cartilage degeneration was assessed using the International Cartilage Repair Society grade at primary surgery and again at second-look arthroscopy. Articular surfaces of the medial/lateral femoral condyles, the medial/lateral tibial plateaus, the patella and the trochlea were divided into several subcompartments (MF 1-9, LF 1-9, MT 1-5, LT 1-5, P 1-9, T 1-3). Clinical evaluations used the Japanese Knee Injury and Osteoarthritis Outcome, Lysholm, and International Knee Documentation Committee scores. Second-look arthroscopic findings showed complete healing of the MM posterior root in all patients. Significant differences between pullout repair and second-look arthroscopy were observed for MF 2 and 4, LF 7, and P 7. All clinical outcomes were improved. Our results indicate that this technique improves clinical outcomes postoperatively and may prevent the progression of cartilage degenera-tion on the loading surface of the medial knee compartment.

Steep posterior slope of the medial tibial plateau is associated with ramp lesions of the medial meniscus and a concomitant anterior cruciate ligament injury.

BACKGROUND: Medial meniscus (MM) tears are associated with both acute and chronic anterior cruciate ligament (ACL) insufficiency and can lead to degenerative changes in the knee. ACL reconstruction (ACLR) combined with the meniscal repair was reported to result in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term. However, a subtle tear of the MM posterior segment, also known as a ramp lesion, is difficult to detect on conventional magnetic resonance imaging (MRI) and is frequently missed in ACL-deficient knees. However, there are few studies about the associations between bone geometry and ramp lesion of the MM. This study aimed to compare sagittal medial tibial slope (MTS), medial tibial plateau depth (MTPD), and coronal tibial slope (CTS) between ACL-injured knees with and without ramp lesion of the MM. We hypothesised that patients with ramp lesion of the MM and a concomitant ACL injury have a steeper MTS and shallower MTPD than those without ramp lesion of the MM. METHODS: Twenty-seven patients who underwent ACLR (group A), and 15 patients with combined MM repair (group AM) were included in the study. Anterior tibial translation (ATT) was measured under general anaesthesia just before surgery using a knee arthrometer. MRI was performed in the 10°-knee-flexed position. The MTS and MTPD were measured on sagittal view, and the CTS was measured on coronal view. These parameters were compared between the groups. Differences in MRI measurements or patient demographics between the groups were evaluated using the Mann-Whitney U test. RESULTS: No significant difference was observed in demographic data and post-operative side-to-side difference in ATT between both groups. Pre-operative ATT was significantly higher in group AM than in group A (P < 0.05), whereas post-operative ATT was similar in both groups. Further, Pre-operative ATT was significantly higher in patients with MTS ≥5.0° than in those with MTS <5.0° (P < 0.05). In groups A and AM, the MTS were 3.6° ± 1.8° and 6.2° ± 2.9°, the MTPD were 2.0 ± 0.5 mm and 2.1 ± 0.6 mm, and the CTS were 2.5° ± 1.8° and 2.4° ± 1.6°, respectively. Patients in group AM had a significantly steeper MTS compared to those in group A (P < 0.01), whereas MTPD and CTS were nearly the same in both groups. When the MTS cut-off value was set at 5.0°, the sensitivity and specificity for ACL injury with concomitant ramp lesion of the MM were 0.73 and 0.76, respectively. CONCLUSION: A steep posterior slope of the medial tibial plateau is a risk factor for ramp lesion of the MM associated with an ACL injury. Especially in patients with MTS ≥5.0°, an occult MM ramp lesion should be strongly suspected, and surgeons should prepare for MM repair in combination with ACLR.

Intraarticular lengths of double-bundle grafts can change during knee flexion: Intraoperative measurements in anatomic anterior cruciate ligament reconstructions.

BACKGROUND: The lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HYPOTHESIS: We hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. METHODS: Thirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. RESULTS: The intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DISCUSSION: This study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. LEVEL OF EVIDENCE: IV; retrospective cohort study.